Articles: acute-pain.
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Burn pain is often under treated. Burn patients suffer from daily background pain as well as procedural pain. Direct mechanical and chemical stimulation to peripheral nociceptors, peripheral- and central sensitization contribute to the pathophysiology of pain. The purpose of this review is to discuss the current management of burn pain and also to stimulate future studies. ⋯ There is no clear evidence to show that the use of opioids in acute pain may increase the likelihood of developing opioid dependency. Thus, pain after burn injury should be aggressively treated using pharmacologic and non-pharmacologic approaches. Further controlled studies are yet to be conducted to define appropriate treatments for different burn patients and to establish standard treatment protocols for burn pain.
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Cardiac marker sensitivity depends on chest pain duration at the time of sampling. Our objective was to estimate the sensitivity, specificity, and likelihood ratios of early CK-MB and myoglobin assays in patients presenting to the emergency department (ED) with nondiagnostic ECGs, stratified by the duration of ongoing chest pain at the time of ED assessment. ⋯ Regardless of chest pain duration, single assays and early serial markers (0+1 hr) do not rule out AMI; therefore, serial assays over longer observation periods are required. Likelihood ratios derived in this study will help physicians who use Bayesian analysis to determine post-test AMI likelihood in patients with chest pain.
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This paper outlines 3 cases of acute isolated peroneal (lateral) compartment syndrome following exertion, minor trauma or overuse. Compartment syndromes are usually associated with crush injuries or fractures; they are an uncommon development following minor trauma or overuse. In acute isolated peroneal compartment syndrome the diagnosis is often delayed, resulting in permanent impairment. ⋯ Marked increase in pain with passive inversion and dorsiflexion of the ankle should suggest the diagnosis. In cases that present late or where the diagnosis is initially missed, there is often a common peroneal nerve palsy. As with all compartment syndromes, prompt diagnosis and surgical decompression is necessary to prevent permanent impairment.
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Rofecoxib was the first specific inhibitor of cyclooxygenase-2 (COX-2) approved for the treatment of acute pain. It has been shown to provide analgesia that is significantly better than placebo and has an onset of action and efficacy similar to that of traditional nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen and ibuprofen. In addition, the analgesic efficacy of rofecoxib has been demonstrated to be superior to that of the opioid combination of codeine 60 mg/acetaminophen 600 mg in an acute dental pain model. ⋯ Rofecoxib is a safe and highly effective alternative to previously available NSAIDs and should be considered for the treatment of acute pain conditions in adult patients, especially those at risk for developing gastrointestinal complications. It is preferred in the perioperative setting because of its analgesic efficacy and lack of platelet effects. Because of its more favorable gastrointestinal toxicity profile compared with nonselective NSAIDs, rofecoxib is safer in patients, especially older patients, for whom chronic anti-inflammatory or analgesic therapy is indicated.
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Rofecoxib is a cyclo-oxygenase 2 selective inhibitor. This systematic review of rofecoxib in acute pain examined studies in adults of analgesic efficacy over six hours, the amount and quality of the evidence on extended duration of analgesia, and the quality and quantity of evidence on adverse events. ⋯ Rofecoxib at 2-4 times the standard daily dose for chronic pain is an effective single dose oral analgesic in acute pain. Limitations in trial reporting constrain conclusions about longer duration of analgesia and adverse event profile.